Melissa A Brockman, PT
Individual provider Active NPI Physical Therapist · Algoma, WI
NPI 1083624712 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1083624712
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5171024 (WI)
- Practice address
- 1510 Fremont St
Algoma, WI 54201-1948 - Phone
- (920) 487-3676
- NPI assigned
- Aug 8, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5171024 | WI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5171024 | WI | Yes |
Addresses
Primary practice location
1510 Fremont St
Algoma, WI 54201-1948
Mailing address
1510 Fremont St
Algoma, WI 54201-1948
Phone (920) 487-3676
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5171024 | Other | WI | LICENSE |
Other names
- Melissa A Bain
Other providers in Algoma, WI
- Aurora Pharmacy Inc
- Bellin Memorial Hospital Inc
- Bellin Psychiatric Center Inc
- William F Bluett
- Allycia E Bretl
- C & P Oaks Algoma LLC
- City of Algoma
- D G Kenny DC SC
- Rachel Lani Davis
- Door County Memorial Hospital
All providers in Algoma, WI · Physical Therapist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.